Exercise as it relates to Disease/The effect of exercise on rheumatoid arthritis

Rheumatoid Arthritis (RA) is one of the most common autoimmune diseases in the world[1]. It is a chronic inflammatory disease associated with erosive synovitis, which if left untreated will lead to joint destruction[1]. This leads to disability and an increased risk of premature mortality[1]. The onset of RA is generally between 30 to 50 years of age[2] and commonly affects more woman than men[3]. The cause of RA is unknown, however it is believed that 50% of the risk of developing RA is due to genetic factors[4]. Environmental risk factors such as smoking are also believed to be linked[4]. Symptoms can include; sudden onset of joint pain, swelling in multiple joints, morning stiffness, inability to perform daily activities and disturbed sleep due to pain[1].

The chronic inflammation involved in RA may lead to a number of systemic complications including[5]:

Rheumatoid nodules

Vasculitis

Vasculitis- associated neuropathy

Interstitial lung disease

Felty's syndrome

Patients with an autoimmune disorder such as RA, have an increased risk of developing non-hodgkins lymphoma and sjorgren's syndrome due to chronic lymphocyte stimulation[5]. Cardiovascular disease (CVD) is also associated with RA as a result of physical inactivity[5].

RA patients are usually started on a range of pharmaceuticals to reduce disease activity[1]. Some patients are unresponsive to these therapies[1]. The anti-inflammatory effects of exercise may help to reduce the risk of developing complications, other autoimmune diseases and increase cardiovascular health[6]. Further, exercise promotes overall health and helps to reduce joint pain[7]. Exercise that positively affects RA includes;

Improves muscle function in the lower limbs and also improves the mental capacity to tolerate pain[10]

60 minutes twice a week[10]

If the patient has any co-morbidities such as hypertension, obesity or diabetes, then a doctors approval must be secured before exercise programs can begin. If the patient is under time constraints, aerobic exercise should be recommended over other forms of exercise. This is because aerobic exercise promotes overall health, reduces risk of co-morbidities and has the greatest therapeutic effect to reduce joint pain[7]. Also, exercise such as jogging and heavy weight lifting should be avoided as they promote joint damage[9].